Changning District medical and health institutions chemical waste disposal status of investigation
|Keywords||Medical waste Chemical reagent Chemical disinfectant Cross-sectional study|
Medical waste refers to waste products with direct or indirect infectivity, toxicity and some other perniciousness, produced from medical care, disease prevention, health care and some other activities by the medical and health institutions. These medical wastes showed great danger to public as they included some noxious substances, such as contagious bacteria, virus, chemical pollutant and radioactive substances. Medical waste is recognized as "top danger" and "fatal killer" overseas which has been listed in <Basel Convention> in 1989. In China, medical waste is considered as the primary waste among the 47 kinds of hazardous wastes which are listed in <The National Dangerous Wastes Catalogue>. Because of the irregular management and improper handle, medical waste caused polluting the environment, spreading diseases and threatening the health. Medical waste management has become the hot spot of society.According to the catalogue of medical waste classification, medical waste is classified five categories including infectious, pathological, traumatic, drug-induced and chemical. Chemical medical waste is highly flammable, explosive, corrosive and poisonous, which mainly comes from scrap chemical reagent produced from medical imaging department and laboratory; waste chemical disinfectant such as peracetic acid and glutaraldehyde; mercury from scrap sphygmomanometer or thermometer. Sensitive material waste contains lots of silver halide and other harmful substances produced from medical imaging department. If solid and water waste can’t be disposed effectively and safe, lots of recoverable and reusable precious metals will be lost. Silver ion and reducing substances, organic compounds and acidic material caused water pollution. The film piece is polymers which can not be degraded in the environment. Such chemical disinfectant as peracetic acid, glutaraldehyde has strong oxidation, toxicity and irritation. The chemical properties are unstable while the consumption is larger. Without free-pollution disposal and discharge into the urban sewage pipe network, it will cause water acidification. The athology laboratory use chemical reagents such as formaldehyde, xylene, and mercury from scrap sphygmomanometer or thermometer will cause the aberrance, cancer and mutation as well as cause the water pollution. At present, among the medical waste generated by the medical and health institution, Infectious and pathological medical waste is much more than chemical medical waste which easily leads the medical staffs to ignore its dangers. In addition, the investment in faclitiles, the fund input and the agreement with Entity of concentrated disposal of medical wastes can affect disposal work quality. The medical and health institutions dispose chemical medical waste itself, without free-pollution disposal and discharging into the urban sewage pipe network, collection and conservation of chemical medical waste long time, the inadequacy ability of medical waste recycling, buried safe hidden trouble working and caused the severe harm to the social, economy and environment.Objective1. To investigate the chemical medical waste disposal process of separate collection, internal transport, temporary storage, recycling and other disposal process which is generated in the medical and health institutions in Changning District of Shanghai.2. Analyze the problems in the process of disposing chemical medical waste, strengthen the management of chemical medical waste and prevent human infection, the spread of disease, poisoning and environmental pollution caused by the chemical medical waste. Safeguard the health and protect the ecological environment. Provide the reference to the government decision-making department.MethodsBy stratified sampling method,45 medical and health institutions in Changning District of Shanghai were sampled. The chemical medical waste disposal process of separate collection, internal transport, temporary storage, recycling and other disposal process which is generated in medical imaging department, athology laboratory, medical laboratory, stomatology department, endoscopic room, hemodialysis room were investigated by investigation team. By stratified sampling method,40 hospitals in Changning District of Shanghai were sampled. By simple stochastic sampling method,3-5 nursing staffs were selected and investigated by questionnaires. After being sorted, collected data would be collected and summarizing by Excel and analyzed by methods with SPSS13.0.Results1. Waste chemical reagent and chemical disinfectant are generated by the medical and health institutions. While only a few X-ray film, scrap mercury sphygmomanometer or thermometer generated. Chemical medical waste were generated in medical imaging department, athology laboratory, medical laboratory, stomatology department, endoscopic room, hemodialysis room, which has extensive sources and caused the severe harm to the social.2. Medical and health institutions pay attention on the disposal of infectious and pathological medical waste. Besides sensitive material waste can be disposed safe, the other waste chemical reagent and chemical disinfectant cannot be disposed effectively and safe.3. Most chemical medical waste is liquid, which are highly flammable, explosive, corrosive, and poisonous. These characteristics increase the difficulty to disposal of separate collection and recycling. The main factors that influenced on disposal of chemical medical waste were lack of the entity of concentrated disposal of hazardous waste, medical equipments design used liquid straight into sewer way and high concentrated disposal charge.4. Nursing staffs have a basic knowledge for medical waste. Better cognition degree in the sanitary requirement, health protection and tools disinfection. Poorer cognition degree for understand of "management ordinance of medical waste", qualification certification and storage time in medical waste.5. There were significant differences in the cognition degree of medical waste between the public and private medical and health institutions. There were no significant differences in the cognition degree of medical waste between the private medical institution and clinic. 20-29 age stages, secondary education, less than five years work experience of nursing staffs have low cognition for medical waste.Conclusion1. Chemical medical wastes should be adopted disposal of centralized recovery, and we should reduce the use of chemicals. Use digital medical imaging to replace the traditional analog imaging in the medical imaging department. Use the pressure steam sterilization instead of chemical sterilization. Pressure stram sterilization is effectiver and economic. Disinfectant effectiveness of acid electrolyzed oxidizing water is better than glutaraldehyde on endoscope. Use stearic acid and tissue clearing reagent to replace the xylene in the athology laboratory. It can reduce the harm of human and environment. Use test kits to replace the chemical reagent preparation work in the medical laboratory. It can save test time, and the results will be more exact.2. Supervision, law enforcement and health education guidance should be strengthened according to management ordinance of medical waste from health supervision department and the environmental protection department. Health supervision department should strengthen in supervise and control. Internal and external medical waste management system design properly for the control of the generation, classify collection, storage, transportation and final disposal during the whole process. The environmental protection department should strengthen monitor to prevent canceal and discard chemical medical wastes. Actively design and develop the low toxicity and environment-friendly chemicals from the source material, reducing environmental risks, strengthen environmental moral education.3. The sense of professional risk and protection of nursing staffs should be improved. The medicial and health institutions should pay more attention on the young, less educated, less experience nursing straff, and peovide more training to them.4. Health supervision department should improve guidance and service for nursing staffs. Provide training for hospital to enhance their senses of hygiene and occupational physical examination to reduce health damage risk.